Bernard Klionsky

The significance of meconium staining

Meconium staining of the placenta and/or fetal body was present at birth in 10.3 per cent of 42,000 live-born infants, but present disproportionately in 18.1 per cent of 788 neonatal deaths. The neonatal mortality rate was 3.3 per cent in the stained group and 1.7 per cent in the nonstained group. Among infants who died, the incidence of erythroblastosis was quadrupled and that of cardiovascular malformation was doubled in the stained group. Meconium staining was associated with a decrease in the expected frequency of hyaline membranes and atelectasis even in premature infants; hypotheses for this phenomenon were presented. Meconium staining of the fetus or placenta requires several hours of exposure. As a hypothesis, the observed increase of deaths in stained neonates may be related to the stresses of cumulative or chronic hypoxia which may occur after the initial passage of meconium if delivery is prolonged.?23AUTHOR

Carcinoma of the vagina following cervical cancer

Vaginal carcinomas at Magee‐Womens Hospital were reviewed for a 25‐year period: 51 were cases of invasive carcinoma and 23 were of carcinoma in situ. Invasive vaginal carcinoma accounted for 2.1% of all female genital tract neoplasms. Of the 23 cases of in situ carcinoma of the vagina, 16 (70%) were synchronous with or subsequent to cervical cancer; of the 51 with invasive vaginal carcinoma, 14 (27%) had concurrent or antecedent cervical cancer. This strikingly high frequent association of vaginal cancer with cervical neoplasia emphasized the multicentric occurrence of carcinoma in the lower female genital tract. The importance of lifelong periodic clinical and cytologic examinations of all patients with or without a history of previous cervical neoplasia is stressed for the detection of early vaginal lesions.

Differences between white and Chinese populations in human leukocyte antigen sharing and gestational trophoblastic tumors

The prevalence of gestational trophoblastic tumors varies widely among different populations: it is lowest in whites (3 to 6/100,000) and highest in Chinese (68 to 202/100,000). This observation suggests that the origin of the disease is different in the two populations. To test this hypothesis, we examined couples in whom the woman developed a gestational trophoblastic tumor in a white population (Pittsburgh) and a Chinese population (Taiwan) for sharing of human leukocyte A, B, DR, and DQ antigens, which we consider markers for sharing of major histocompatibility complex-linked recessive genes affecting both embryogenesis and carcinogenesis. No human leukocyte antigen sharing occurred between partners in Pittsburgh, but there was significant human leukocyte antigen sharing in Taiwan. The latter couples shared human leukocyte antigen B (p less than 0.04) and human leukocyte antigen DQ (p less than 0.007) and shared three or more human leukocyte A, B, DR, and DQ antigens (p less than 0.02) significantly more frequently than did normal couples. However, there was no increased sharing of any specific human leukocyte antigen allele. These findings support the hypothesis that gestational trophoblastic tumors occur on a sporadic basis in whites and on a genetic basis in Chinese.

An unusual gastric bezoar in a newborn: Polystyrene resin and Candida albicans

amounts of bil irubin removed by the procedure would have to be compared. Al though this was not done in our evaluation, we believe tha t the similari ty of the volumes of the exchanged blood and the t ime of the procedure support the in terpre ta t ion tha t the greater decrease in serum bil irubin concentrat ion represents more bil irubin removed. Our prel iminary experience has indicated tha t the exchange transfusion technique is safe and effective and may avoid many of the potential problems inherent in previously used techniques.

Congenital pericarditis due to maternal lupus erythematosus

The structural alteration of the glomerular capillary basement membranes in hereditary nephritis may be related to the lack of normal adult GBM antigen(s) or to persistence of neonatal GBM antigen(s) in this condition. Both the characteristic ultrastructural defect and the failure to localize anti-GBM antibodies are useful in the pathologic diagnosis of hereditary nephritis. REFERENCES 1. Spear GS, and Slusser RJ: Alports syndrome. Emphasizing

Transplacental passage of maternal erythrocytes with sickling

Sickled erythrocytes served as a marker for maternal, blood in a cell transfer study of placentas from uncomplicated term pregnancies of women with sicklemia. The incidence of concurrent sickling in maternal and fetal blood was 100% in the 44 cases examined. Maternofetal passage of the erythrocytes was found four times more frequently in umbilical or chorionic veins (8.4%) than in arteries (1.9%). Deported chorionic villi were found in the veins in three of 44 cases but not in the arteries. These findings indicate fresh maternofetal leakage of blood during the third stage of labor.

Yellow hyaline membrane disease in neonates: clinical diagnosis by tracheal aspiration cytology.

Yellow hyaline membrane disease (YMH) of the neonate may be diagnosed clinically by tracheal aspiration cytology, an easily accessible, noninvasive, and safe technique. Since the frequent association of yellow membranes and kernicterus in premature infants at relatively low levels of serum bilirubin is significant, this means of diagnosis during life may be useful in identifying infants at risk for kernicterus. We also suggest use of this technique in evaluating the role of possible factors in the pathophysiology of yellow hyaline membranes.

TRANSPLACENTAL PASSAGE OF MATERNAL ERYTHROCYTES WITH SICKLING

Sickled erythrocytes served as a marker for maternal blood in a cell transfer study of placentas from uncomplicated term pregnancies of women with sicklemia. The incidence of concurrent sickling in maternal and fetal blood was 100% in the 44 cases examined. Maternofetal passage of the erythrocytes was found four times more frequently in umbilical or chorionic veins (8.4%) than in arteries (1.9%). Deported chorionic villi were found in the veins in three of 44 cases but not in the arteries. These findings indicate fresh maternofetal leakage of blood during the third stage of labor.

CYTOHISTOLOGIC DIAGNOSIS OF UTERINE JET WASH PREPARATIONS

To determine the efficacy of the uterine jet washing technique (Gravlee 1964) in endometrial cancer testing the Cytology Laboratory at Pittsburghs Magee-Womens Hospital analyzed the results of 230 washings obtained from 211 patients from May 1971 to March 1973. Average patient age was 46 years. In 125 cases a corresponding histologic specimen was available (through endometrial biopsy hysterectomy or dilatation and carettage) as a correlative sample. The uterine jet washings were evaluated in concentrated monolayers indirect smears and cell block preparations. Histologic diagnoses were possible in 150 of 230 cases (65.2%) cytologic diagnoses only were possible in 72 cases (31.3%) and 8 specimens were unsatisfactory (3.5%). 125 jet washing diagnoses were consistent with correlated surgical specimen interpretations and no false positive diagnoses were made. Data suggest that the endometrial jet washing technique is a reliable diagnostic office procedure which could prove superior to endometrial biopsy because in addition to obtaining microbiopsies it can recover desquamated fragments and cellular samples from the endometrial cavity. The technique is neither a routine procedure nor a replacement for the conventional cervical and vaginal smear method for mass screening of asymptomatic patients but serves as a valuable aid to better detection of suspected endometrial lesions and can provide a means for follow-up observation of a treated or untreated lesion when dilatation and curettage is undesirable.